After three years off due to the COVID-19 pandemic, the Ragon-MIT course HST.434 returned this January to provide 24 students a once in a lifetime learning experience

Education is a crucial element of the Ragon Institute’s global mission, a vital asset in giving the next generation of researchers the tools to combat diseases like HIV, COVID, and future pandemics. The “Evolution of an Epidemic” course at the Massachusetts Institute of Technology is a longstanding part of this work that we were thrilled to bring back this year.

The fight against HIV/AIDS is global, but it is also a disease with vastly disparate outcomes across regions. 

According to the Joint United Nations Programme on HIV and AIDS (UNAIDS), HIV prevalence in the US is 0.9%. In South Africa, the prevalence rate is 14%–a country home to one fifth of all people with HIV in the world. In areas where the Ragon Institute and collaborating organizations work, the local prevalence among young women living in poverty exceeds 50% by age 25, a number that is truly challenging.

“Evolution of an Epidemic” provides MIT undergraduate students the opportunity to travel across South Africa during the January intersession–to understand how HIV causes disease and how the body fights back, to discuss with local healthcare providers how they face the challenges of treating HIV, to see firsthand how care is provided in a resource-constrained setting, and to interact directly with those most affected by the virus.

The course is sponsored by MIT Science and Technology Initiatives (MISTI) with cultural and health/safety training provided by MIT-Africa.

“We are really delighted that we were able to start it up again this year after a few years’ pause because of COVID-19,” said Ragon Institute founding director Bruce Walker, MD. “COVID has emerged and is now also part of the course, but HIV has not gone away.”

Nineteen MIT students participated in the course led by Walker and Mass General Brigham’s Howard Heller, MD, early this January. Upon landing in South Africa, they were joined by five students from the African Leadership Academy (ALA), a long standing collaborator of the Ragon and one of the most prestigious secondary schools on the continent.

Together, these 24 students set off on the first leg of the trip in Johannesburg, South Africa’s largest city.

A Window into the Healthcare System

One of the first stops was the sprawling ALA campus in the northern suburbs of Johannesburg. Gifted students recruited from across Africa listened to introductory lectures by Dr. Walker and Dr. Heller that provideda broad overview of the HIV crisis and South Africa’s response, and how addressing the HIV pandemic aided the response to COVID-19. 

The group also attended a talk by former South African Supreme Court Justice Edwin Cameron, a prominent activist for LGBTQ+ rights and for people with HIV. 

Justice Cameron talked about his career, and shared his experience finding out that he had HIV in the 1990s when the stigma surrounding the disease was far worse, as well as his views about the current and future state of the HIV crisis in the country.

Cameron also answered students’ questions, inviting them to challenge him and offering his perspective on issues like international intervention, the cases he has presided over, and the illegitimacy of anti-LGBTQ+ laws passed by African governments in recent years.

It was a thought-provoking and unusually honest talk that allowed students to hear directly from a person who has held a position of leadership in the country, and a powerful way to kick off the experience of being in South Africa.

The second day was framed around the centerpiece of the Johannesburg leg– visit to the Witkoppen Clinic, which provides health services, testing, and counseling to low-income patients in the surrounding area.

The clinic is situated in a suburb where the nearest public hospital is at least 45 minutes away by car, making it the only nearby source of medical care for many low-income residents of the area.

Many patients, according to the clinicians, will sleep outside the night before in order to receive care the next day. Since the clinic only has enough resources to see a certain number of patients each day, the demand can often be overwhelming.

The experience was sobering for the students and gave an in-depth look at what an overwhelmed healthcare system can look like for many low-income patients across the Global South.

Clinic leadership also took time out of their day to host a roundtable with the students and provide insight into the challenges they faced each day, as well as the reasons they felt compelled to work at the clinic.

“They’re all wicked good at their jobs and they care deeply about their patients,” MIT student Abby Schipper said. “They’re dealing with diseases like TB, where we see a couple of cases of TB every year in Boston, and they’re dealing with far more than that every day. The amount of persistence and care for the patient that that takes is inspiring to see.”

The last day in Johannesburg was dedicated to visiting the Apartheid Museum, a deeply powerful site that commemorates South Africa’s reckoning with its history of racial discrimination and violence.

After three full days taking in Johannesburg, the students set off on the next leg of their journey.

The Human Impact

Durban is a coastal city located in South Africa’s  KwaZulu-Natal province, home to several Ragon Institute programs and collaborators and the epicenter of HIV in the country.

The students’ first stop was the Nelson Mandela School of Medicine at the University of KwaZulu-Natal, home to the African Health Research Institute (AHRI) and CAPRISA, the Centre for the AIDS Programme of Research in South Africa.

The cutting-edge research facilities at AHRI were established through a collaboration with the Ragon Institute and funding provided by the Doris Duke Foundation and Howard Hughes Medical Institute, and is one of the leading research institutes on the continent. It  was the first institution in the world to identify the Omicron variant of COVID-19, which spread rapidly around the globe in December 2022.

CAPRISA co-founders Dr. Salim Abdool-Karim and his wife, Quarraisha Abdool-Karim, both among South Africa’s leading public health figures, gave students a tour of the CAPRISA labs and participated in a discussion with Walker that illuminated the South African response to the COVID-19 pandemic with leaders who were on the ground from the beginning.

The next day was a highlight for many as students visited the traditional healers, or sangomas, who are part of ITEACH. This Ragon program provides training and certification for traditional healers to provide HIV/AIDS counseling to their patients, many of whom will consult a traditional healer long before seeing a doctor.

The healers welcomed the students to rural Umlazi township, offering prayers, blessings, a traditional meal followed by dancing, and the opportunity for students to ask and learn more about their culture and calling as traditional healers. 

The course continued with an exploration of the Ragon’s other international pillar, FRESH (Females Rising Through Education, Support, and Health), which provides counseling, testing, education, and mentorship to young at-risk women in the township in order to reduce their risk of HIV infection while providing support if they do contract the virus.

Students were given a tour of the FRESH facility, as well as the opportunity to participate in roundtable Q&A sessions with program participants and women in BabyU, the maternity program within FRESH.

“It was incredible hearing from these women about how their outlook on life just changed so much after they were able to go through these leadership classes, learning computer skills, finding jobs, and changing their lives after FRESH,” MIT student Sydney Pyon said. “Being able to see that direct impact on people that we’ve been working closely with over the course of the trip was very meaningful.”

The day concluded with home visits where students split up into small groups and were welcomed into the homes of FRESH participants across Umlazi. It was a powerful opportunity for the MIT students to understand what the day-to-day lives of the participants look like and the impact that FRESH is having on them and their families.

“It showed me that these people are more than statistics that we see on paper and that their lives are actually being affected by this disease,” ALA student Ngaatendwe Wisdore Kodogo said.  “Getting to hear about their experiences, what they went through, was life-changing and made me want to continue pursuing a career in healthcare.”

The final leg of the journey began as the students traveled hours by bus out of Durban and into rural areas of KwaZulu-Natal.

Underserved Populations

The bulk of the students’ time on this leg was spent at AHRI’s Somkhele Clinic, its satellite facility located in the countryside of the province near several villages.

Students continued their course lectures while also being given the opportunity to present mini-”Shark Tank” talks about how they would solve pressing health challenges. Additionally, students visited AHRI’s mobile health clinics within the local villages, each of which provides counseling and resources to patients who otherwise have no access to healthcare or clinical services,  sharing information and referrals for patients with HIV.

Additionally, they employ local residents as counselors who inform their community about prevention and treatment options and guide them towards assistance from the clinicians.

The group also visited Queen Nandi Regional Hospital, home to the BabyU program. It is there that the project’s HIV-positive mother-child pairs attend weekly screenings and counseling as part of the FRESH program.

Students once again broke apart into smaller groups to have personal conversations with participating mothers and learn about how their diagnosis changed their lives as well as how BabyU is making a difference for their families.

“It was one thing that stuck with me, interacting with those mothers going through BabyU, because a lot of them brought their babies and then we all bonded together,” MIT student Arianna Doss said. “Their babies were absolutely adorable but also just listening to the moms and having that shared experience and something to bond over as women, I enjoyed that and will definitely remember it for a long time.”

Finally, to conclude their 10-day journey, students spent the last three days at the Hilltop Camp within the Hluhluwe-Imfolozi Park, South Africa’s oldest game reserve.

While it was an incredible opportunity to see Africa’s wildlife and get up close with the big-five (rhinos, lions, elephants, leopards, and buffalos) on sunrise and sunset game drives, this stay was also a culmination of the students’ learning experience.

All students presented their final group presentations, which they had been working on for the duration of the course. Topics ranged from the creation of a practical and enforceable masking policy to preparing for an unspecified future pandemic, with each topic leaving plenty of room for interpretation and depth.

It was a meaningful opportunity for students to display how the experience had shaped their learning and was a fitting way to conclude their course. With a final day of game drives and a long journey ahead, students were sad to see this year’s “Evolution of an Epidemic” course come to an end.

“I gained a lot of new perspectives. I didn’t know that much about HIV or South Africa, and I think this trip immediately broke that barrier for me,” said MIT student Gordon Su. “It’s been one of the most informative experiences of my life and I think it definitely has had a big impact on what many of us want to do in the future when it comes to healthcare.”

Looking back on this year’s course, Bruce Walker said he enjoyed the opportunity to bring students back to South Africa and provide a hands-on educational experience.

“The course is fun to teach,” he said. “And my sense from the years now that we’ve been doing it is that it’s having a transformational effect on the students who get a chance to participate in it. And that’s important for the future.”